Conscience is central to how we understand human behaviour, but there is surprisingly little agreement about how to assess it systematically in adolescents. In clinical practice, professionals often have to rely on their experience and intuition.

New tool developed

Tiemersma investigated whether this could be improved by developing a shared, theoretically grounded way of describing conscience. This led to the development of the Clinical Assessment of Conscience (CAC), a structured tool designed to help professionals describe how a young person’s conscience functions.

Tiemersma’s CAC provides a common framework. Professionals draw on interviews, observations, information from other people and existing records to assess 12 items covering empathy, self-conscious emotions and moral reasoning. The result is not simply a score indicating whether someone has a conscience, but a more detailed picture of how its different elements function.

More complicated than just ‘right’ or ‘wrong’

‘Having a conscience is not simply a matter of knowing right from wrong,’ says Tiemersma. ‘It is about being able to understand other people, experience emotions such as guilt and shame, and use moral reasoning – and, crucially, having these abilities work together.’

But conscience not only regulates our behaviour towards other people; it also helps regulate our sense of who we are. When something threatens our self-image, it can trigger emotions such as guilt, shame or embarrassment. Shame can make us feel that we are a bad person, while guilt is more focused on something we have done – and can motivate us to put it right. In this sense, conscience helps us maintain a coherent and positive sense of self.

The heavier the trauma, the greater the fragmentation

One of Tiemersma’s most striking findings came from a study of 88 clinically referred adolescents aged 12 to 23. The young people completed questionnaires about their experiences of childhood trauma and were assessed using the CAC.

The results showed that greater trauma severity was associated with weaker integration between the three components of conscience. Adolescents with high levels of trauma showed greater inconsistency between empathy, self-conscious emotions and moral reasoning, suggesting a more fragmented conscience.

The type of trauma also mattered. Emotional neglect had the strongest association with disrupted conscience integration, followed by emotional and sexual abuse. In other words, different forms of childhood adversity may affect conscience in different ways.

‘A fragmented conscience does not necessarily mean that a young person has no empathy, no guilt or no understanding of right and wrong,’ says Tiemersma. ‘It may mean that these abilities are not working together effectively. That is a very different way of looking at problematic behaviour.’

Working towards an integrated conscience

For Tiemersma, the value of the research lies in making sense of behaviour that can otherwise be difficult to understand. It suggests that treatment may need to focus not only on strengthening individual abilities such as empathy or moral reasoning, but also on helping them become better integrated. This could ultimately contribute to more effective interventions for trauma-affected young people and, potentially, help reduce the risk of delinquent behaviour.

‘If we know which parts of a young person’s conscience are functioning well and which are struggling to work together, we can potentially tailor treatment more precisely,’ she says. ‘The goal is not simply to label a young person as having a deficient conscience, but to understand what has happened to their development and where there is room for change.'